Key principles of motivational interviewing

The four key principles that underlie motivational interviewing are

Expressing empathy,
Developing discrepancy,
Rolling with resistance
Supporting self-efficacy.

The following scenarios place these principles within the context of working in the field of eating disorders.

Expressing Empathy:  Show More

    When communicating with a loved one with an eating disorder, conflict is futile and may even send the sufferer deeper into his/her ED cave. We help carers with reflective listening skills to understand their loved one’s feelings and perspectives without judging, criticizing or blaming. When expressing empathy, the aim is not acceptance but, rather, to gain a deeper understanding of the person’s perspective. Ambivalence is accepted as normal. Reluctance to change problematic behaviour is to be expected, otherwise the person would have changed before reaching this point.

    Sufferer: I just get so frustrated with you all …always nagging on about eat this, eat that… I want to tell you once and for all, there is absolutely nothing at all wrong with me so can both just get off my back!

    Carer: I can imagine you feeling pretty angry, especially if you believe so strongly that there’s nothing at all wrong with your eating and that we’re always on your back.

    In the above scenario the carer listens to her daughter without judgment or advice-giving and simply reflects back what she is hearing by using empathy in order to gain a better understanding of the situation.

    Here motivational interviewing is used to create and amplify a discrepancy between present behaviour and broader goals and values, i.e. future goals and the present state of affairs.

    Sufferer: I don’t know why you’re on my back so much. I just don’t feel like eating. I’m huge and if it was up to you, you’d have me stuffing myself like a pig….

    Carer: I guess dad and I are a bit confused. You were speaking last night about how much you were looking forward to starting university in October, yet you’ve been losing weight at an alarming rate and your doctor has told you that you may have to be admitted to hospital unless you gain some.

    This scenario exemplifies the skills we encourage carers to utilize with their loved one with an eating disorder. Here the carer develops discrepancy between her daughter’s goals and dreams for the future that are important to her and her current behaviour. When skilfully done, developing discrepancy can change the person’s perceptions without creating any sense of being pressured or coerced into a new behaviour.

    Arguments and criticism tend to be counterproductive. Not only is the ambivalent person unlikely to be persuaded or pushed, but angry confrontation is also more likely to push the person in the opposite direction, i.e. into a defensive mode.

    Sufferer: OK, here’s where I’m at. You’re telling me I’ve got to eat dinner and I’m telling you I won’t. Nothing you can do will make me change my mind so why not save your breath and my head because your nagging just isn’t going to do it…..

    Carer: OK, we both need a bit of a break here. I feel my anxiety levels rising so I’m going to take myself off for a walk. You have your meal plan from the Unit and you know what needs to be done before you begin university in September. Tell you what… let’s talk about this when we’ve calmed down a bit

    Self-efficacy refers to the person’s belief in his or her ability to carry out and succeed with a specific task. Self efficacy is a key element in motivation for change and is a reasonably good predictor of treatment outcome(2).

    Sufferer: I just find life so very tough, my mind is just so jumbled up 24/7 with food, calories, weight, I try to hard…and nothing seems to take these thoughts away.

    Carer: I can imagine it’s pretty tough for you. However, I also know that you’ve always been such a determined person and strong too and that you can beat this.

    Our Practical Skills section of the website will take carers through MI skills in more detail.